This document provides guidance on appropriate use of the ColonRing device for colorectal anastomoses. It discusses checking patient and surgical factors before use, such as bowel prep, comorbidities that may impact healing. It also addresses potential issues that may be encountered like mucous plugs, foreshortened bowel, or thick fibrotic tissue. The document provides accommodations for different situations like diverting ostomies or modifying the anastomosis technique. It aims to help users safely and properly apply the ColonRing device for colorectal anastomoses.
About 500,000 vasectomies are performed every year in the US, and an increasing number of men chose this option instead of having their wife go through a more invasive, often intra-abdominal procedure under general anesthesia. Vasectomies are cost-effective, in-office procedures, and usually have a quick recovery.
Austin urologist Dr. Koushik Shaw explains everything you need to know, from the procedure to the recovery. If you're ready for a consultation, you can book an appointment at http://www.austinurologyinstitute.com/.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
ABSTRACT- The purpose of this study was to access the outcome of modified manual small incision cataract surgery (M-MSICS) in terms of postoperative visual recovery (Best Corrected Visual Acuity). In this prospective study, the patients having cataracts with nuclear sclerosis not more than early grade 3 were randomly assigned in 2-groups with 50- patients in each group [Group A (C-MSICS), Group B (M-MSICS)]. Both techniques were compared for each stage in terms of postoperative visual recovery (Best Corrected Visual Acuity). Follow ups in postoperative period were carried out on 1st and 3rd postoperative days, 2 weeks, 4 weeks and 6 weeks. Significant early postoperative visual recovery was observed in Modified manual small incision cataract surgery (M-MSICS) as compare to conventional technique. Postoperative surgical induced astigmatism at 6 weeks was significantly less in M-MSICS group (p<0.05%). So it can be concluded that M-MSICS is better technique than C-MSICS in terms of early postoperative visual recovery & less postoperative surgical induced astigmatism.
Key-words- Conventional manual small incision cataract surgery (C-MSICS), Modified manual small incision cataract surgery (M-MSICS), Postoperative visual outcome
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
Peritoneal adhesions are a common cause of bowel obstruction, pelvic pain, and infertility. More often than not, these adhesions need to be released surgically for the management of these complications.
About 500,000 vasectomies are performed every year in the US, and an increasing number of men chose this option instead of having their wife go through a more invasive, often intra-abdominal procedure under general anesthesia. Vasectomies are cost-effective, in-office procedures, and usually have a quick recovery.
Austin urologist Dr. Koushik Shaw explains everything you need to know, from the procedure to the recovery. If you're ready for a consultation, you can book an appointment at http://www.austinurologyinstitute.com/.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
ABSTRACT- The purpose of this study was to access the outcome of modified manual small incision cataract surgery (M-MSICS) in terms of postoperative visual recovery (Best Corrected Visual Acuity). In this prospective study, the patients having cataracts with nuclear sclerosis not more than early grade 3 were randomly assigned in 2-groups with 50- patients in each group [Group A (C-MSICS), Group B (M-MSICS)]. Both techniques were compared for each stage in terms of postoperative visual recovery (Best Corrected Visual Acuity). Follow ups in postoperative period were carried out on 1st and 3rd postoperative days, 2 weeks, 4 weeks and 6 weeks. Significant early postoperative visual recovery was observed in Modified manual small incision cataract surgery (M-MSICS) as compare to conventional technique. Postoperative surgical induced astigmatism at 6 weeks was significantly less in M-MSICS group (p<0.05%). So it can be concluded that M-MSICS is better technique than C-MSICS in terms of early postoperative visual recovery & less postoperative surgical induced astigmatism.
Key-words- Conventional manual small incision cataract surgery (C-MSICS), Modified manual small incision cataract surgery (M-MSICS), Postoperative visual outcome
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
Peritoneal adhesions are a common cause of bowel obstruction, pelvic pain, and infertility. More often than not, these adhesions need to be released surgically for the management of these complications.
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. The Next Era in GI Surgery BioDynamixTM Anastomosis The Colon Ring DIFFICULT SITUATIONS Clinical Training Team BEWARE!! Shark-infested Waters
2. 2 Appropriate Use of ColonRingTM Check w/ surgeon before case to see if ColonRingTM is appropriate to use— Ileostomy closure (above ileocecal valve)— Right hemicolectomy (not initial case)— Bowel prep— Patient co-morbid conditions—
3.
4. 5 Appropriate Use of ColonRingTM Check w/ surgeon before case to see if ColonRingTM is appropriate to use— Bowel prep— What may happen? Hard stool proximally may force premature evacuation of the ring complex. What should be should be suggested? Minimum required: 1-2 Fleets enemas preop, stool softeners 2 days preop & 7 days postop.
5.
6. Colonic lavage
7.
8. 8 Appropriate Use of ColonRingTM The ring complex is “smart” regarding the necrotic process, but it is unaware of the stage of the surrounding healing process!
9. 9 Appropriate Use of ColonRingTM But, what if the surgeon advises you that the patient has requested confidentiality of diagnosis? Ask if there is any history or evidence of delayed healing.
10. 10 Appropriate Use of ColonRingTM In the presence of delayed healing— Emphasize benefit of proximal diversion. “When in doubt, skip out!”
11. To Divert or Not to Divert…That is the Question! Why to divert?— Diversion definitely decreases the severity of anastomotic leaks! Why not to divert?— Consequences of unnecessary stomas— Second surgery required Necrosis or retraction of stoma Prolapse or peristomal herniation Social implications Difficulties in care: leakage, appliance application Odor Appearance under clothing 11
12. 12 Colostomy Closure Colostomy closure (primarily Hartmann reversal)— This procedure may frequently cause more potential problems than expected due to various factors mostly related to the delay between the initial operation and the subsequent closure. What might you suspect if it is noted that the applier does not appear to insert fully to the distal rectal stump or the orange mark at the base of the trocar is not seen? Mucous plugs—
13. 13 Colostomy Closure – Mucous Plugs Mucous plugs— What is a mucous plug? Mucus becomes inspisated (dried out & hardened like concrete). What is the effect of mucous plugs? May present difficulties with closing the device. May prevent device from advancing to end of rectal stump. May prevent device from closing completely. Accommodation: Preoperative enemas Intraoperative endoscopy & removal End-to-side (anterior) anastomosis
14. 14 Colostomy Closure—Fore-shortened Segment Colostomy closure— What can happen with a bowel segment not used for a long period? Fore-shortened segment— Lack of stool passage through the distal segment often results in contraction of the segment. What problems will this present? Less length is available for anastomosis. Thicker wall results due to contraction. Accentuated interference from valves of Houston. Accommodation: Re-dissection of perirectal space will help. Additional splenic flexure takedown may be required.
15. 15 Colostomy Closure – “Strictured” Areas Colostomy closure— What additional problem may prevent insertion of applier into rectal segment? “Strictured” areas— Previously mentioned fore-shortening may lead to apparent “strictured” areas which are actually tortuosities of the lumen rather than true strictures, but they may still make introduction of the device difficult. Accommodation: Re-dissection of perirectal space will help. Introduction of 28 mm dilator should assure adequate entry.
16. 16 Colostomy Closure – Thick Fibrotic Tissue Colostomy closure— Thick fibrotic tissue— What is the problem with this situation? Fibrosis of the prior staple line usually results in fibrotic, thickened, minimally compressible end of distal rectal stump which may cause difficulty in forming an appropriate anastomosis. Accommodation: Resection of fibrotic staple line area; restaple or purse-string. End-to-side (anterior) anastomosis.
17. 17 Ring Loading Problems Ring loads improperly on the applier— Often due to excessive pressure applied during loading, especially if the ring is rotated excessively, stripping the plastic locking tabs. May result from too little or unequal pressure on loader. Accommodation: Demonstrate proper loading techniques before procedure to involved individuals.
18. 18 Anvil Retention Problems The anvil will not remain secured to the trocar— Usually due to excessive tissue present between the anvil and ring. Most often seen with reversal of Hartmann. May result with use of double purse-strings. Accommodation: Resect excessive tissue around purse-strings. Resect fibrotic distal staple line in Hartmann reversal. Perform side-to-side, end-to-side, or side-to-end anastomosis. Assist closure of device with gentle pressure on anvil head.
19. 19 Improper Mating of Anvil & Trocar When is the anvil seated properly? When does the anvil lock in place? Can the device be fired without the anvil properly attached to the trocar? Can the cutting handles be fired? Will the anastomosis be formed? Can the device be opened? Will the ring remain attached to the applier? When does the mechanism actually push the ring off the device handle? When you notice the anvil and trocar fail to mate and separate, at what point would you need to take the device out to be sure the ring is still firmly seated before reconnecting the trocar and anvil and continuing?
20. 20 Improper Cutting of Anvil Head Blade won’t cut anvil head after ColonRingTM and anvil head are mated— What may have happened? Incomplete closure of device. Lack of depression of cutting trigger. Incomplete firing of cutting handle. Instrument failure.
21. 21 Proper Cutting of Anvil Head – No Anastomosis! Blade cut anvil head after firing ColonRingTM handles but no anastomosis is formed— What may have happened? Most likely ColonRingtm was not loaded on applier!!! Accommodation: Assure that surgeon always checks to make sure that the ColonRingtm has been properly loaded before attempting to insert the applier.
22. 22 Cross-Utilization of Parts Cross-utilization of parts of two separate ColonRing units— What may happen? Potential for improper result is higher. Devices are tested as a complete unit.
23. Difficulty in Withdrawing Applier If withdrawal of the applier appears to place traction on the anastomosis— Consider possibility of “vacuum” in rectal segment— Support distal side of anastomosis. 23
24. Difficulty in Withdrawing Applier If withdrawal of the applier appears to place traction on the anastomosis— Applier remains attached to ring complex— Attempt repeat cutting with cutting handle; If success— Additional testing. Visualization of anastomosis?? Diversion?? If no success— Open applier proximal to warning “click”. Remove anastomosis anvil/ring complex from trocar. Close applier distal to warning “click”. Remove applier. Resect anastomosis and re-do. 24
25. 25 Increased Size of Bowel Lumen If the size of the proximal bowel lumen appears too large— Consider removing excess tissue around the purse-string to prevent an improper anastomosis. Consider placing the anvil through the side of the proximal segment (and secure it with a quick purse-string).
26. 26 Decreased Size of Bowel Lumen In the presence of a lumen appearing smaller than 27 mm— Open along anti-mesenteric border Bring anvil out through side of intestine (Recommend quick purse-string)
29. Surgical removal may be necessary.Accommodation: Consider end-to-side anastomosis (anterior) below “stricture”. Resect close to stricture and complete anastomosis as desired. 27